COMMISSION CONSENT DISCLOSURE FORM

Why is consent required?

In 2024, the Corporations Act 2001 was modified under the Treasury Laws Amendment (Delivering Better Financial Outcomes and Other Measures) Bill (DBFO).

Under the DBFO a Retail client must provide informed consent for a broker to earn insurance commissions when being provided with Personal Advice . If a broker does not obtain the client’s consent the broker will contravene the conflicted remuneration provisions.

The informed consent requirements come into effect on 9 July 2025.

It is a legal requirement for us to obtain your consent before we can receive commission from an insurer. For further details on how we are remunerated for our services please refer to our Financial Services Guide and Terms of Engagement.

Please note that once you provide your consent it is irrevocable, and provided the commission we earn remains within the range and frequency disclosed below, your consent will also apply for:

each renewal; and
any future (new) purchase of one or more of the products listed below.

IMPORTANT: If we do not receive your consent, we may not be able to place your insurance policy, and you may be left uninsured if you do not make alternative arrangements.

When cover is placed, you can refer to the Insurer section on your document for details of the insurer and the Statement of Advice or Personal Advice Statement (as applicable) for details of the exact dollar amount we will earn as commission, for each policy we place for you.

How often and how much insurance commission will we earn?

We receive commission calculated as a percentage of the premium amount that you pay for each policy. The commission we receive will vary between products, but will be up to 30% of the premium amount for each of the following products:

Motor vehicle insurance
Home building and/or home contents insurance
Sickness and accident insurance
Consumer credit insurance
Travel insurance
Personal and domestic property insurance
Medical Indemnity insurance

Should you have any questions about which product category above your policy falls into, please contact your broker

What you need to do

Once you have familiarised yourself with the above, complete your details below. A copy of your consent will be forwarded to you and saved on your file for our records.

Legislative Update On Your Insurance Programme - Important Information

I acknowledge I have read and understood the above disclosures and agree to the commission being paid to the broker.

I acknowledge the above as the Insured or if not the Insured, do so with the authorisation of the Insured to provide this consent on their behalf.

Print Name

Email Address

Date Declared

Contact Number

• If there is an imminent threat or dangerous circumstances	NSW SES – 132 500
• Building repairs / make safes	Johns Lyng Group – 1300 73 6000
• Water extraction / restoration / clean-up etc	Restorx 1300 73 6333 or Steamatic 1300 783 262

Office: info@abcitystate.com.au or	02 4297 1800
Claims Manager: Andrew Nanos	0459 777 114
Managing Director: Bob Grbevski	0420 301 773
Director: Brian Barreto	0403 948 007

Commission Consent Disclosure Form

COMMISSION CONSENT DISCLOSURE FORM

I acknowledge I have read and understood the above disclosures and agree to the commission being paid to the broker.

I acknowledge the above as the Insured or if not the Insured, do so with the authorisation of the Insured to provide this consent on their behalf.